Objective To discuss shortterm effect of rotating hinge knee prosthesis. Methods From July 2002 to April 2005, 17 cases of severe knee joint deformity and instability received rotating hinge knee prosthesis for total knee arthroplasty. There were 8 males and 9 females, aging from 41 to 79 years. The left joints were involved in 10 cases and right joint in 7 cases. All patients were admitted because of pain. The course of disease was from 1 to 7 years. There were 10 cases of osteoarthritis，5 cases of rheumatoid arthritis，1 case of traumatic arthritis after operation of left femur fracture，and 1 case of traumatic arthritis with injury of anterior cruciate ligament, meniscus medialis and medial collateral ligament after operation of left fracture of tibial plateau. According to HSS(hospital for special surgery) scoring system，the preoperative score was 36 to 58 with an average of 48.6. The preoperative flexed motion range of articulation was 21° to 80° with an average of 57.4°. Results All patients were followed up from 7 months to 3 years with an average of 23.6 months. There were no complications of thrombogenesis of veins of lower extremity, pulmonary embolism, palsy of peroneal nerve, fracture, and breakage of extended knee structure. Infection occurred in 1 case at 3 months postoperatively，the prosthesis was dislodged，antibiotic-impregnated cement was filed with knee joint，twostage arthroplasty was expected. At the last follow-up,the HSS score was 78 to 98 with an average of 91.1 in 16 patients. The flexed motion range of articulation was 75° to 100° with an average of 852° at 2 weeks postoperatively. The flexed motionrange of articular was 85° to 123° with an average of 1083° at the last followup. There were significant differences in HSS score and motion range of articular between preoperation and thelast follow-up (P＜0.05). Conclusion The short-term outcome of rotating hinge knee prosthesis is good and a long term followup is necessary.
ObjectiveTo estimate the early effectivenss of computer navigation-assisted total knee arthroplasty (TKA) by comparing with traditional TKA.MethodsThe clinical data of 89 patients (100 knees) underwent primary TKA between October 2017 and July 2018 were analyzed retrospectively, including 44 patients (50 knees) who completed the TKA under the computer-assisted navigation system as the navigation group and 45 patients (50 knees) treated with traditional TKA as the control group. There was no significant difference between the two groups (P>0.05) in gender, age, body mass index, diagnosis, side, disease duration, Kellgren-Lawrence classification of osteoarthritis, and preoperative American Hospital for Special Surgery (HSS) score, range of motion (ROM), hip-knee-ankle angle (HKA) deviation. The operation time, incision length, difference in hemoglobin before and after operation, postoperative hospital stay, and the complications were recorded and compared between the two groups. The HSS score, ROM, and joint forgetting score (FJS-12) were used to evaluate knee joint function in all patients. Unilateral patients also underwent postoperative time of up and go test and short physical performance battery (SPPB) test. At 1 day after operation, the HKA, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), sagittal femoral component angle (sFCA), and sagittal tibial component angle (sTCA) were measured and calculated the difference between the above index and the target value (deviation); and the joint line convergence angle (JLCA) was also measured. ResultsThe operations of the two groups were successfully completed, and the incisions healed by first intention. The operation time and incision length of the navigation group were longer than those of the control group (P<0.05); the difference in difference of hemoglobin before and after the operation and the postoperative hospital stay between groups was not significant (P>0.05). Patients in the two groups were followed up 27-40 months, with an average of 33.6 months. Posterior tibial vein thrombosis occurred in 1 case in each of the two groups, and 1 case in the control group experienced repeated knee joint swelling. The HSS scores of the two groups gradually increased after operation (P<0.05); HSS scores in the navigation group at 1 and 2 years after operation, and knee ROM and FJS-12 scores at 2 years were significantly higher than those in the control group (P<0.05). There was no significant difference in the postoperative time of up and go test and SPPB results between the two groups at 7 days after operation (P>0.05); the postoperative time of up and go test of the navigation group was shorter than that of the control group at 2 years (t=–2.226, P=0.029), but there was no significant difference in SPPB (t=0.429, P=0.669). X-ray film measurement at 1 day after operation showed that the deviation of HKA after TKA in the navigation group was smaller than that of the control group (t=–7.392, P=0.000); among them, the HKA deviations of 50 knees (100%) in the navigation group and 36 knees (72%) in the control group were less than 3°, showing significant difference between the two groups (χ2=16.279, P=0.000). The JLCA and the deviations of mLDFA, mMPTA, sFCA, and sTCA in the navigation group were smaller than those in the control group (P<0.05).ConclusionCompared with traditional TKA, computer navigation-assisted TKA can obtain more accurate prosthesis implantation position and lower limb force line and better early effectiveness. But there is a certain learning curve, and the operation time and incision length would be extended in the early stage of technology application.
To investigate an effect of tranexamic acid on blood loss associated with total knee arthroplasty (TKA).Methods From June 2005 to June 2006, 102 patients (43 males, 59 females; aged 59-77 years, averaged 68 years) underwent TKA. Of the 102 patients, 59 had osteoarthritis, 23 had rheumatoid arthritis, and 20 had traumatic arthritis.The illness course ranged from 2 to 12 years. They were randomized divided into Group A and Group B of 51 patients each. The patients in Group A received tranexamic acid, and the patients in Group B received an equal volume of normal saline. In Group A, 1 g of tranexamic acid dissolved in 250 ml of normal saline was intravenously infused before deflation of the tourniquet; another intravenous administration of the same drug of the same dosage was given 3 hours later. In Group B, only 250 ml of normal saline was infused intravenously. The amounts of blood loss and blood transfusion during operation and after operation in all the 102 patients were recorded. They were also observed for whether they had deep vein thrombosis. D-dimeride, fibrinogen, prothrombin time, and activated partial thromboplastin time were also examined before operation, during operation (deflation of the tourniquet), and 3 hours after operation.Results The blood loss was 256±149 ml in Group A and 306±214 ml in Group B during operation; there was no significant difference between the two groups（P＞0.05）. The postoperative drainage volume was 478±172 ml in Group A and 814±156 ml in Group B, and the total blood loss was 559±159 ml in Group A and 1.208±243 ml in Group B; there were significant differences between the two groups (P＜0.05). The averaged amount of blood transfusion was 556±174 ml in Group A and 1 024± 278 ml in Group B; there was a significant difference between the two groups (P＜0.05). The postoperative hemoglobin concentration was higher in GroupA than that in Group B (1.0-1.1 g/dL vs. 0.6-0.8 g/dL). The ostoperative follow-up for 612 months revealed that no deep vein thrombosis was found in both lower limbs of the patients by the color Doppler ultrasonography. The level of D-dimeride was significantly higher 3 hours after operation than before operation (0.92±0.56 mg/L vs. 0.35±0.13 mg/L in Group A; 1.32±0.79 mg/L vs. 0.37± 0.21 mg/L in Group B) (P＜0.05). The D-dimeride level 3 hours after operation was significantly higher n Group B than in Group A（P＜0.05）. There were no significant differencesin the levels of fibrinogen, prothrombin time, and activated partial thromboplastin time between the two groups（P＞0.05）.Conclusion During and after the TKA operation, a shortterm use of tranexamic acid can significantly decrease blood loss and blood transfusion with no increasing risk for venous thrombosis.
ObjectivesTo systematically review the efficacy of absorbable barbed suture versus traditional absorbable suture in total knee arthroplasty (TKA).MethodsPubMed, EMbase, The Cochrane Library, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect clinical trials of absorbable barbed suture versus traditional absorbable suture in TKA from inception to November, 2017. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 6 randomized controlled trials (RCTs) and 5 cohort studies were included, involving 2 008 patients. Meta-analysis showed that the joint capsule suture time of the absorbable barbed suture group [MD=–4.31, 95% CI (–4.72, –3.90), P<0.000 01], the incidence of acupuncture injury during suture [OR=0.14, 95% CI (0.03, 0.61),P=0.009], and incision complication rate [OR=0.56, 95% CI (0.36, 0.88), P=0.01] were significantly lower than the traditional absorbable suture group, but the incidence of suture fracture [OR=23.03, 95% CI (3.08, 172.09),P=0.002] was higher, yet the difference was statistically significant. There were no significant differences in the incidence of superficial infection, deep infection, aseptic redness, incision dehiscence and KSS score at 3 months after operation (P>0.05).ConclusionsAvailable evidence suggests that the use of absorbable barbed sutures to close the TKA surgical incision shortens the time to suture the joint capsule, reduces the incidence of acupuncture injury as well as the overall incidence of incision complications without increasing superficial infection, deep infection, and sterility. The incidence of redness and incision splitting has no significant effects on joint function at 3 months after surgery, however the incidence of suture fracture is higher. Due to limited quality and quantity of the included studies, the above conclusions are required to be verified by more high-quality studies.
Objective To evaluate the radiographic and postoperative function of computer navigation versus traditional methods for total knee arthroplasty through meta-analysis. Methods we searched the specialized trials registered in Cochrane muscle group, The Cochrane Library (CCTR), MEDLINE (1966 to 2009), EMbase (1980 to 2009), PubMed (1966 to 2009), NRR (http://www.update-software.com/National/), CCT (http://www.controlled-trials.com), and CBMdisc (1979 to July 2009), and we manually searched some Chinese orthoopaedics journals. Data were extracted and evaluated by two reviewers independently. Randomized controlled trials of computer navigation and traditional methods for total knee arthroplasty were included. The quality of the included trials was critically assessed. RevMan 4.2.8 software was used for data analysis. Results Eighteen RCTs of computer navigation and traditional methods for total knee arthroplasty were included. A total of 2 349 patients met the inclusion criteria for the review. The results showed that, computer navigation versus traditional methods for the total knee arthroplasty: a) about radiography: there was difference in the precise measurement of lower limbs mechanical axis (WMD= –?0.56, 95%CI –?0.74 to –?0.38, Plt;0.00001), but no obvious difference in measurement of the femoral frontal axis (WMD= –?0.29, 95%CI –?0.58 to 0.00, P=0.05), sagittal axis (WMD= –?1.64, 95%CI –?3.49 to 0.21, P=0.08) and angle of rotation (WMD= –?0.11, 95%CI –?0.87 to 0.66, P=0.79). Obvious difference was not found in the tibial frontal axis (WMD= –?0.31, 95%CI –?0.69 to 0.06, P=0.10), but found in the tibial sagittal axis (WMD= –?0.69, 95%CI –?1.10 to –?0.28, P=0.001). No difference was found in the tibiafemoral angle (WMD= 0.03, 95%CI –?0.78 to 0.84, P=0.95), patella tilt angle (WMD= –?1.45, 95%CI –?3.12 to 0.22, P=0.09) and patella angle of rotation (WMD= –?0.34, 95%CI –?0.71 to 0.02, P=0.06); b) there was obvious difference in operating time (WMD= 13.31, 95%CI 10.00 to 16.63, Plt;0.000 01), but no obvious difference in the complications (RR= 1.65, 95%CI 0.87 to 3.13, P=0.13) and the hemorrhage volume (WMD= –?74.81, 95%CI –?184.71 to 35.09, P=0.18); and c) about the evaluation of postoperative function: the follow-up in all studies was more than 6 months; there was no obvious difference in joint motion (WMD= –?2.17, 95%CI –?5.66 to 1.33, P=0.22), KSS scores (WMD= 6.28, 95%CI –?3.69 to 16.25, P=0.22), and OXFORD scores (WMD= –?0.31, 95%CI –?2.05 to 1.43, P=0.72). Conclusions Compared with traditional methods, computer navigation using for the total knee arthroplasty: a) is much accurate in measurement of the lower limbs mechanical axis and tibial sagittal axis, but is not superior in measurement of the femoral frontal axis, femoral sagittal axis, femoral angle of rotation, tibial frontal axis, tibiafemoral angle, patella tilt angle, and patella angle of rotation; b) may spend a longer operating time if not performed by proficient for it is a kind of new technique realm, but is similar in decreasing complications and hemorrhage volume; and c) is not obvious different in function evaluation after over 6 months follow-up which has to be further studied.
Effective postoperative pain management in patients undergoing total knee arthroplasty is an important part of the realization of enhanced recovery after surgery. Peripheral nerve block is of great significance to the control of postoperative pain, and clinicians are committed to finding a nerve block that has little impact on muscle strength and is conducive to the early recovery of motor function after total knee arthroplasty. Infiltration between the popliteal artery and capsule of the knee block can selectively block the sensory branch of the posterior end of the knee joint without affecting the motor branch of the common peroneal nerve, so that the muscle strength can be minimally affected under the condition of adequate analgesia. This article reviews the proposal of infiltration between the popliteal artery and capsule of the knee block, the approach and method of the block, and the advantages of combining with different nerve blocks for analgesia after total knee arthroplasty.
【Abstract】 Objective To compare the two different techniques determining tibial rotational al ignment in total kneearthroplasty(TKA) to enhance postoperative effect and reduce compl ications. Methods From May 2006 to April 2007, 60 patients(27 males, 33 females, aged 55-78 years ) received TKA and randomly divided into 2 groups(n =30): tibial rotational al ignmentin TKA was determined by medical 1/3 of tibial tubercle in Group A, by medial border of tibial tubercle at 0-9°varus inGroup B, by medical 1/3 of tibial tubercle at 20°or greater varus or by the mean l ine between medial border of tibial tubercle andmedical 1/3 of tibial tubercle at 10-19°varus. The angle of rotation of polyethylene cushion was calculated. Results The angleof rotation of polyethylene cushion in Group A was (8.4±3.8)° at 0-9°varus, (3.5±2.7)° at 10-19°varus and (0 ±2.4)° at 20°varusor over, respectively, and there was significant difference (P lt; 0.05). The angle of rotation of polyethylene cushion in Group Bwas (0 ±2.1)° at 0-9° varus, (0 ±2.0)° at 10-19°varus and (0 ±1.7)° at 20°varus or over, respectively, and there was no significantdifference (P gt; 0.05). The angle of rotation of polyethylene cushion averaged (5.6±2.8)°in Group A and (0±1.9)° in Group B,showing significant difference (P lt; 0.05). Conclusion The range of ideal tibial rotational al ignment in TKA was from medialborder of the tibial tubercle to medical 1/3 of the tibial tubercle, and is decided by the degree of varus deformities and valgus deformities.
Objective To compare the efficacy and safety of aspirin and rivaroxaban in the prevention of venous thromboembolism (VTE) after total knee arthroplasty (TKA). Methods Eight databases were searched, including Cochrane Library, Embase, Web of Science, PubMed, SinoMed, Wanfang, Chongqing VIP, and China National Knowledge Infrastructure. The search period was from the establishment of databases to June 2023. All randomized controlled trials of aspirin and rivaroxaban for the prevention of VTE after TKA were collected, and meta-analysis was conducted using RevMan 5.3 software. Results A total of 7 articles were included, with a publication period from 2014 to 2022, including a total of 714 patients, including 356 in the aspirin group and 358 in the rivaroxaban group. The meta-analysis results showed that the incidence of deep venous thrombosis in the lower limbs of the aspirin group was higher than that of the rivasarb group [relative risk (RR)=1.53, 95% confidence interval (CI) (1.09, 2.16), P=0.01], and the incidence of bleeding complications was lower than that of the rivaroxaban group [RR=0.66, 95%CI (0.52, 0.82), P=0.0003]. There was no statistically significant difference in the incidence of wound complications between the two groups (P>0.05). Conclusion The efficacy of rivaroxaban in preventing VTE after TKA is better than that of aspirin, but there is an increased risk of bleeding complications.
ObjectiveTo explore the gait trajectory characteristics and effectiveness after unicompartmental knee arthroplasty (UKA).MethodsThirty patients (30 knees) with anterior medial compartment osteoarthritis who were treated with UKA between January 2017 and December 2018 were selected as subjects (UKA group). According to age, gender, and side, 30 patients (30 knees) with knee osteoarthritis treated with total knee arthroplasty (TKA) were selected as control (TKA group). In addition to the range of motion (ROM) before operation showing significant difference between the two groups (t=4.25, P=0.00), there was no significant difference in gender, age, disease duration, sides, body mass index, and preoperative hip-knee-ankle angle (HKA), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score between the two groups (P>0.05). The incision length, drainage volume within 24 hours after operation, and the changes of hemoglobin and albumin were recorded. The WOMAC score, ROM, and HKA before and after operation were compared between the two groups. At 1 year after operation, the gait trajectory characteristics of two groups were analyzed by Vicon three-dimensional gait capture system, and the absolute symmetry index (ASI) of the lower limbs of the two groups was calculated.ResultsThe incisions of the two groups healed by first intention, with no complications. The incision length, drainage volume within 24 hours, and the changes of hemoglobin and albumin after operation in the UKA group were significantly smaller than those in the control group (P<0.05). All patients were followed up completely, the follow-up time ranged from 13 to 20 months of UKA group (mean, 18 months) and 16 to 24 months of control group (mean, 20 months). The imaging review showed that the lower limb alignment of the two groups were restored to a neutral position, and the position of prosthesis was good. At 1 year after operation, the WOMAC score, HKA, and ROM of two groups were significantly improved when compared with those before operation (P<0.05); the postoperative WOMAC score and ROM of the UKA group were significantly better than those of the control group (P<0.05), and there was no significant difference in HKA between the two groups (t=1.54, P=0.13). Gait analysis at 1 year after operation showed that the walking speed, stride length, knee extension at mid-stance, and flexion at swing in the UKA group were significantly better than those in the TKA group (P<0.05); there was no significant difference in cadence, knee flexion at initial contact, and knee flexion at loading response between the two groups (P>0.05). The ASI of bilateral knee flexion in the UKA group was significantly greater than that in the TKA group during the initial contact and loading response period (P<0.05).ConclusionCompared with TKA, UKA has the advantages of small incision, less blood loss, and quicker functional recovery. The early gait after UKA is mainly manifested as the increase in walking speed, stride length, knee flexion at swing, and extension at mid-stance phase. From the analysis of gait symmetry, during the initial contact and loading response phase, the operation side after UKA undertakes more shock absorption and joint stabilization functions than the contralateral side.
ObjectiveTo compare the cost changes of total knee arthroplasty (TKA) before and after the cancellation of medical consumables addition, so as to provide reference for the national medical reform policy.MethodsThe patients treated with TKA between September 2018 and February 2019 were admitted as objects of study, and 372 of them met the selection criteria and were finally included in the study. According to the time node of cancelling the medical consumables addition (December 24, 2018), all patients were allocated to pre-cancelling and post-cancelling groups (n=186). The clinical data of patients (gender, age, length of stay, disease classification), and various treatment costs (the costs of diagnosis and treatment, examination, laboratory, material, anesthesia, bed, nursing, operation, drug, and others) were collected. And the changes of various costs and proportions before and after cancelling the medical consumables addition were compared.ResultsThere was no significant difference in gender, age, and disease classification between the two groups (P>0.05); the length of stay after cancelling the medical consumables addition was significantly longer than that before cancelling (t=2.114, P=0.035). There was no significant difference in the total cost of TKA before and after cancelling the medical consumables addition (t=0.214, P=0.831). Compared with that before cancelling the medical consumables addition, the cost of material was significantly reduced, and the costs of diagnosis and treatment, anesthesia, nursing, and operation were significantly increased (P<0.05); the costs of examination, laboratory , bed, drug, and others were basically stable, and the differences were not significant (P>0.05).ConclusionThe total cost of TKA is stable, the proportion of material cost is significantly reduced, the proportion of diagnosis and treatment cost reflecting the technical content of medical staff is significantly increased, which is in line with the expectation of the national policy of cancelling the medical consumables addition.